MODERN PENTATHLON
2012 USA PENTATHLON REGIONAL
CLINICAND CHAMPIONSHIPS
We are pleased to invite you to the 2012 USA Pentathlon Regional Clinic and Championships Clinic at
The New Mexico Military Institute in Roswell, New Mexico
June 28 through June 30, 2012.
JUNIOR and YOUTH A YOUTH B YOUTH C
(age 21under) (age17 – 18) (age 15 – 16) (age 14 and younger)
Swim: 200 Meters Swim: 200 Meters Swim: 100 Meters
Combined 3x1000m/5shots Combined 2x1000/5 Run: 1K, Shoot: 20 shots
Riding (only juniors)/Fencing Fencing Fencing
VENUES:
FENCING(GodfreyAthleticCenter)EPEE – One touch round robin
SWIMMING(Godfrey Athletic Center)25m, indoor pool
COMBINED(Stapp Parade Field)1000 m loop/grass/air pistol
RUNNING(Stapp Parade Field)Youth C - 1000 m loop/grass
SHOOTING(DowHallShootingRange)Youth C - 20 shots at 10 meter distance
ENTRY FEE:
- $180 – Regional Championships Competition and Clinic
ACCOMMODATIONS
Hotel of your choice
Meals (NMMI cafeteria) 3 meals per day $ 20.00
- Airport shuttle service.
- Shuttle service from hotel to venues every day
SCHEDULE:Two days clinic – Thursday and Friday
Thursday, June 28th6:00 am First day of Clinic
Friday, June 29th7:00 pm End of Clinic
COMPETITION
SaturdayJune 30th 7:30 FENCE Warm upGodfrey 8:00 FENCE START Godfrey
11:00SWIMWarm upGodfrey
11:30SWIMSTARTGodfrey
12:40COMBINEDWarm upStapp Parade Field
13:10COMBINEDSTARTStapp Parade Field
15:00RIDING (juniors) warm upBierwirth stable
16:00 AWARDS CEREMONYTBA
AWARDS:Top three athletes in each division for Boys and Girls
2012NMMI YOUTH PENTATHLON
CLINICCOMPETITION June28 to June 30
ENTRY FORM
Entry form and payment must be postmarked no later than June 10, 2012
Data of application ______
Last Name ______First Name ______Sex: M F
Birthdates ___/___/___ Age _____ Passport/Visa # (international competitors): ______
Address ______City ______
State ______Zip Code ______Country ______
Parents’ Names ______
Business /Day phone: ______Cell ______
E-Mail Address: ______
Division (for competition) JUNIOR A B C (circle)
FENCING: (Do you own all required fencing gear?)____ YES ____ NO
If no, Please list gear you will need to rent upon arrival:______
SHOOTING: (Do you own a pistol?)____YES ___ NO Please let us know if you need a pistol.
Projected run time (According to age group): 1K ______2K ______3K ______
Projected swim time (According to age group): 100 M: ______200 M: ______
Medical Insurance Information (attach the copy of your insurance card)
Height ………… Weight ………. Blood Type ………….
Medication (s) …………………………………………………………………………………………………………
Conditions: - Epilepsy- Heart - AsthmaInsurance Company: ………………………….
- High Blood Pressure- Diabetes ………………………………………….
- Hearing Aid- Contact LensesPolicy # …………………………………………..
Others:………………………………………………………..Address: …………………………………………..
Allergies- Medications: ……………………………... …………………………………………..
- Other: (list) ………………………………..
TRAVEL INFORMATION:
PLEASE INDICATE WHETHER YOU PLAN TO DRIVE OR FLY: DRIVING ___ FLYING ___
DATE OF ARRIVAL AT NMMI: ___/___/___ DATE OF DEPARTURE FROM NMMI: ___/___/___
FLIGHT INFORMATION (IF APPLICABLE):
ARRIVAL DATE: ____ / ____ / ____ (M/D/Y)ARRIVAL TIME: ______FLIGHT #: ______AIRLINE: ______
DEPART. DATE: ____ / ____ / ____ (M/D/Y) DEPART. TIME: ______FLIGHT #: ______AIRLINE: ______
NMMIAIRPORT SHUTTLE SERVICE NEEDED? __ YES __ NO
……………………………………………… ……………………………………………………………………………………….
Athlete/Parent Athlete signature <or> Parent or legal guardian signature if athlete is under the age of 18.
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